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Case Law Database

Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. ADJ10489999
Regular
Feb 01, 2019

Sean Lawson vs. Zenith Insurance Company

This case involves a dispute over the permanent disability rating for applicant Sean Lawson's low back injury. The defendant, Zenith Insurance Company, argues that the Range of Motion (ROM) method used by the Qualified Medical Evaluator (QME) was inappropriate, and the Diagnosis-Related Estimates (DRE) method should have been applied as there was only one level of radiculopathy. The Workers' Compensation Appeals Board (WCAB) affirmed the WCJ's finding that the ROM method was appropriate based on the QME's expert opinion and the AMA Guides' provision for its use with multi-level involvement. However, one Commissioner dissented, believing the DRE method was mandated given the lack of evidence for multi-level radiculopathy.

WCABPetition for ReconsiderationPermanent DisabilityApportionmentNon-industrial factorsDiagnosis-Related Estimates (DRE) methodRange of Motion (ROM) methodQualified Medical Evaluator (QME)AMA GuidesMultilevel radiculopathy
References
Case No. ADJ6945712
Regular
Nov 29, 2011

CLAY WELDON vs. WALLACE KUHL & ASSOCIATES, U.S. FIDELITY AND GUARANTEE COMPANY

The Workers' Compensation Appeals Board (WCAB) reversed an award of spinal surgery for applicant Clay Weldon. The WCAB found that the Agreed Medical Examiner (AME), Dr. Bruce McCormack, provided substantial medical evidence that the surgery was not reasonable or appropriate at this time. Dr. McCormack's opinion, based on the ACOEM Guidelines and his examination, concluded there was no instability or radiculopathy justifying surgery. The WCAB found the WCJ's reasoning for disregarding the AME's opinion insufficient and therefore rescinded the award.

Workers' Compensation Appeals BoardFindings and Awardindustrial injuryspinal surgeryAgreed Medical ExaminerACOEM Guidelinesutilization reviewsubstantial medical evidenceradiculopathysegmental instability
References
Case No. ADJ11027267
Regular
Feb 03, 2023

LUIS ROSALES vs. IRELAND TILE AND STONE INC., SEDGWICK 14779 SAN DIEGO

This case involves an injured tile setter, Luis Rosales, who claimed lumbar radiculopathy stemming from an admitted industrial lumbar contusion. The Workers' Compensation Appeals Board denied reconsideration of a prior order, upholding a finding of 0% permanent disability. This decision was based on the Qualified Medical Examiner's (QME) reports, which the Board found to be substantial evidence. The Board specifically rejected the applicant's argument that the QME's opinions were inconsistent, clarifying that the QME found the sacral cyst unrelated to the lumbar contusion, not that the symptoms were unrelated to the cyst.

Petition for ReconsiderationQualified Medical ExaminerPQMEDr. Sonusupplemental reportsubstantial evidencelumbar contusionsacral cystradiculopathypermanent disability
References
Case No. ADJ14216452
Regular
Sep 12, 2025

JAIME VILLANUEVA vs. DALEY'S DRYWALL & TAPING, INC.; ARCH INSURANCE

Applicant Jaime Villanueva sought reconsideration of a June 16, 2025 decision that found 0% permanent disability based on a Qualified Medical Examiner's report. The Appeals Board found the QME's report by Dr. Bruce Huffer to be unsubstantial due to its conclusory nature, lack of reasoning, and failure to discuss pertinent medical records from other physicians. Consequently, the Board granted the petition, rescinded the original decision, and returned the matter for further proceedings to properly develop the medical record regarding the applicant's lumbar spine injury and claimed radiculopathy.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardPanel Qualified Medical ExaminerPQMERadiculopathyPermanent DisabilityDRE Lumbar Category IIAMA GuidesSubstantial Evidence
References
Case No. ADJ1220987 (SJO 0262634)
Regular
Nov 17, 2010

RICHARD GILLISPIE vs. PLASTECH, SUBSEQUENT INJURIES BENEFITS TRUST FUND

The Subsequent Injuries Benefits Trust Fund (SIBTF) appealed an award of benefits to an applicant with a pre-existing disability, arguing a subsequent industrial back injury did not cause pathology in the opposite leg as required by statute. The Appeals Board affirmed the award, finding that Labor Code section 4751 only requires the subsequent injury to "affect" the opposite member, not necessarily cause direct pathology. Evidence showed the applicant's low back injury caused verified radiculopathy and impaired leg function, meeting the statutory requirement. The Board found SIBTF's legal arguments unpersuasive and the WCJ's findings supported by substantial evidence.

Subsequent Injuries Benefits Trust FundLabor Code section 4751industrial injurylow backradiculopathypermanent disabilityopposite and corresponding memberpathologyAMA GuidesDRE category III
References
Case No. ADJ7911474
Regular
Jan 22, 2019

KIA SPREWELL vs. STATE OF CALIFORNIA, RICHARD J. DONOVAN CORRECTIONAL FACILITY

This case involved Kia Sprewell's workers' compensation claim against the Richard J. Donovan Correctional Facility for injuries sustained as an office assistant. The defendant sought reconsideration of the initial award, primarily contesting the commutation method for attorney fees and the substantiality of the neurologist's medical opinions. The Workers' Compensation Appeals Board granted reconsideration in part, affirming the award of permanent disability but amending the attorney fees to be commuted from the side of the life pension award. The Board found the neurologist's opinions on apportionment and rating of various injuries, including headaches and spinal issues, to be substantial medical evidence.

Workers Compensation Appeals BoardKia SprewellRichard J. Donovan Correctional FacilityState Compensation Insurance FundPetition for ReconsiderationFindings and AwardPermanent DisabilityApportionmentLife PensionAttorney Fees
References
Case No. ADJ8611746
Regular
Feb 27, 2017

VILMA AGUILAR vs. SLATKIN RESIDENCE, STATE FARM INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the defendant's Petition for Reconsideration. The defendant argued the administrative law judge erred in awarding 17% permanent disability by relying on the applicant's treating physician over a qualified medical evaluator. The Board found the treating physician's opinion was well-supported by objective clinical findings and consistent with the diagnosis of lumbar radiculopathy. Therefore, the Board gave significant weight to the administrative law judge's findings and denied the petition.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardPermanent DisabilityPrimary Treating PhysicianQualified Medical EvaluatorMedical OpinionCredibility DeterminationsSubstantial EvidenceLumbar Radiculopathy
References
Case No. ADJ14808611
Regular
Sep 16, 2022

KATIE Y. LAM vs. COUNTY OF ORANGE, SEDGWICK CLAIMS MANAGEMENT SERVICES

This case concerns an applicant who sought reconsideration of a workers' compensation award denying her claim for neck injury. The Workers' Compensation Appeals Board granted reconsideration, amending the award to include injury to the cervical spine. This amendment was based on the substantial evidence from a Qualified Medical Examiner (QME) whose reports indicated C6 radiculopathy was causally related to the applicant's employment injury. The Board found the QME's opinion well-reasoned and not contradicted by other evidence.

Cervical radiculopathyQMEAOE/COEPetition for ReconsiderationFindings and AwardSubstantial evidenceCompensable consequenceApportionmentDeputy sheriff traineeAmbulatory imbalance
References
Case No. ADJ6668989
Regular
Feb 02, 2018

KAREN GIBBS vs. STATE OF CALIFORNIA, DEPARTMENT OF CORRECTIONS AND REHABILITATION; Legally Uninsured; adjusted by STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration of an award finding the applicant permanently totally disabled. The defendant argued the applicant should not be allowed to include psychological and sleep disorder injuries, that the sleep disorder rating was improperly duplicated, and that the vocational expert failed to account for apportionment. The Board affirmed the WCJ's decision, finding the defendant stipulated to the inclusion of psychological and sleep disorder injuries. Furthermore, the medical and vocational evidence supported the permanent total disability finding even without those additions, and the defendant waived the apportionment issue by not challenging the WCJ's finding of no legal basis for apportionment.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and AwardPetition to ReopenPermanent Total DisabilityCumulative Trauma InjuryRadiculopathyPsyche DisorderSleep DisorderAgreed Medical Examiners
References
Case No. ADJ7186596
Regular
Feb 28, 2011

ANDREW MARTINEZ vs. CITY OF SANTA ROSA, REDWOOD EMPIRE MUNICIPAL INSURANCE FUND

This case involves a defendant seeking reconsideration of a Workers' Compensation Appeals Board (WCAB) award. The defendant argued for a 15% reduction in permanent disability payments based on an offer of regular work, contending it should apply retroactively to all unpaid benefits. The WCAB denied reconsideration, finding the reduction only applies to payments becoming due *after* the work offer was made. The Board affirmed the judge's finding that the defendant had a duty to advance permanent disability payments earlier, due to indications of potential permanent disability from medical reports prior to the offer. Therefore, the 15% reduction under Labor Code § 4658(d) was correctly limited to post-offer payments.

Labor Code § 4658(d)Findings and AwardPermanent DisabilityTemporary DisabilityOffer of Regular WorkPermanent and Stationary DateLabor Code § 4650(b)Labor Code § 4061(a)Advance PaymentsMedical Treatment
References
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